Micro-Neisseria, Moraxella

-aerobic, Gram (-), diplococci -non-pigmented, non hemolytic colonies on Chocolate agar -divided into serogroups based on capsular polysaccharide and serotypes based on outer membrane proteins -Moraxella indistinguishable from Neisseria via Gram stain

-epidemics, "meningitis belt" of Africa in spring and winter -a leading cause of bacterial meningitis, esp. due to serogroup B in the US -capsular polysaccharide (avoids phagocytosis), pili (adhesion to host's pharynx tissue), outer membrane LPS and blebs (tissue damage) -INC risk among pts w/ deficiencies in C5-C8

-meningococcemia: often begins as upper respiratory infection (fever, chills, malaise) or petechial rash-->ecchymoses; rapidly progression; high mortality often due to vacscular collapse and DIC *DIC = disseminated intravascular coagulation -meningitis: abrupt fever, nuchal (neck flexion) rigidity, altered mental status -transient bactermia -diagnosed via Gram stain (-) and cultured CSF/blood

-treated w/ 3rd generation cephalosprorins, except in developing world or cases of allergy -chemoprophylaxis of close pt contacts via Rifampin, ciropflaxin, or ceftraixone -tetravalent vaccine exists, but it ineffective against serogroup B; recommended for travelers, military, adolescents, pts w/ complement deficiencies of asplenia

-major reservoir is asymptomatic pts; peak incidence is adolescents; disease transmitted via sexual contact -capsular polysaccharide (avoids phagocytosis), pili (adhesion to host), lipo-oligosaccharide (stimulates inflammatory response) -adhere to and are engulfed by nonciliated cells of fallopian tube, then multiply w/in phagocytic vesicles prior to release into local tissue (inflammation) and bloodstream; ciliated cells impaired (poor flushing) and sloughed off

-in men, infection usually restructed uretha; symptomatic (burning, dysuria, purulent urethal discharge); potential for epididymitis, prostatitis, anorectal GC -in women, primarily cervix; may be asymptomatic; potential ascending infections inclduing tubo-ovarian abscesses, PID, bartholinitis -potential for disseminated disease: fever, septic arthritis, rash, conjunctitivitis (esp. newborn), pharyngitis -diagnosed via Gram stain (-) of discharge; culture for disseminated disease using Thayer-Martin medium; nucleic aicd probes and urine ampification assay also used

-ceftriaxone or quinolones -increasing incidence of resistance -complications (e.g., due to dissemination) may require prolonged therapy

-prevalence of colonization varies w/ age; adults w/ COPD at INC risk of infection -spread from colonizing site (e.g,. otitis pts w/ organisms in nasopharynx)

-causes 10-15% of otitis media and common cause of bacterial sinusitis -assoc. w/ lower respiratory infections in pts w/ chronic bronchitis and COPD -also assoc. w/ pneumonia in elderly -diagnosis via Gram stain (-) and culture

-all strains produce beta-lactamases -treated w/ macrolides, quinolones, or amoxicillin-clavulanate